Question of the week: are routine MRI scans necessary after breast augmentation?

How can I tell if my implant has ruptured? I had breast implants last year and was wondering if I need to get routine breast ultrasounds or MRI scans? I don’t have a family history of breast cancer.

- patient

Dr Sharp:

Routine MRI or ultrasounds are not recommended unless you:

have a history of breast cancer

have noticed changes in your breasts such as the onset of pain, distortion or discharge

suspect your implant/s may be ruptured

have experienced trauma to your chest and there are concerns that your implant/s may have been damaged

So if you don’t have a history of breast cancer (and aren’t of an age - or family history - to need routine screening yet), regular scans to check on the condition of your implants is not recommended in Australia.

The specific silicone gel filled implants I use are of an extremely high quality; they are covered by a lifetime warranty for rupture. This means the manufacturers back the implant quality, and they will replace them for free if they are to rupture at any point in the future.

Surgeons can also take certain steps to reduce the risk of breast implant rupture at the time of implant placement, including using a Keller funnel to place the implant with minimal impact on the implant itself. I use a funnel for this and other safety reasons when inserting implants.

In the case of silicone implants, if the implant shell develops a small opening, due to its cohesive nature, the silicone gel will most likely remain inside the implant’s outer shell. If a tear develops in the outer shell, the silicone gel may leave the implant, but will usually be contained within the natural scar tissue capsule that forms a few weeks after the implant is placed.

That means you might not notice an immediate difference in your breast. If you do notice a change in your breast, it might be a shape our outline/profile alteration. You might notice some persistent discomfort in the area. As silicone gel is biologically inert, it does not react with your tissues and research shows that when modern cohesive gel implants rupture, they don’t pose an immediate risk to your health.

If you think you might have a rupture:

Visit your GP; they will assess your breast (and symptoms) and may refer you to have a scan. Ask for a referral to see your plastic surgeon; a referral from your GP will enable you to receive a Medicare rebate on your specialist consultation fee.

If you aren’t going back to see your original surgeon, and you don’t have the implant details that were given to you at the time of your augmentation, contact your surgeon to obtain these. This will help you ascertain the type of implants (cohesive gel, saline etc) and the manufacturer’s warranty provisions. Knowing your warranty provisions will help you ascertain the out of pocket costs of any potential revision surgery.

Implants do not last forever; I have seen patients with first-generation implants that have been in place for over 40 years, while other patients have required replacement due to capsular contracture, rupture or migration after 8-10 years.

The good news for women who wish to undergo breast augmentation with modern high quality silicone gel implants is that they are generally very safe and ruptures are rare. When they do occur, they are usually contained within the capsule and easily removed and replaced.

MEET DR DAVID SHARP

David is a Queensland trained Plastic and Reconstructive surgeon. He obtained Fellowship of the Royal Australasian College of Surgeons after undertaking eight years of specialist training in General Surgery and Plastic Surgery. He is a member of the Australian Society of Plastic Surgeons.